Use of ADNF polypeptides for treating peripheral neurotoxicity

ABSTRACT

This invention relates to the use of ADNF polypeptides in the treatment of neurotoxicity induced by chemical agents or by disease processes. The ADNF polypeptides include ADNF I and ADNF III (also referred to as ADNP) polypeptides, analogs, subsequences such as NAP and SAL, and D-amino acid versions (either wholly D-amino acid peptides or mixed D- and L-amino acid peptides), and combinations thereof which contain their respective active core sites.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.11/388,634, filed Mar. 23, 2006 which claims the benefit of U.S.Provisional Application No. 60/664,908, filed Mar. 23, 2005; which isherein incorporated by reference for all purposes.

FIELD OF INVENTION

This invention relates to the use of ADNF polypeptides in the treatmentof neurotoxicity. The present invention also relates to the manufactureof medicaments, methods of formulation and uses thereof. The ADNFpolypeptides include ADNF I and ADNF III (also referred to as ADNP)polypeptides, analogs, subsequences such as NAP and SAL (defined below),and D-amino acid versions (either wholly D-amino acid peptides or mixedD- and L-amino acid peptides), and combinations thereof which containtheir respective active core sites.

BACKGROUND OF THE INVENTION

NAP, an 8-amino acid peptide (NAPVSIPQ=Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln);SEQ ID NO:2), is derived from a novel protein, activity-dependentneuroprotective protein, ADNP (U.S. Pat. No. 6,613,740, Bassan et al.,J. Neurochem. 72: 1283-1293 (1999); Zamostiano, et al., J. Biol. Chem.276:708-714 (2001)). The NAP sequence within the ADNP gene is identicalin rodents and humans (U.S. Pat. No. 6,613,740, Zamostiano, et al., J.Biol. Chem. 276:708-714 (2001)).

In cell cultures, NAP has been shown to have neuroprotective activity oncells of the central nervous system (CNS) at femtomolar concentrations(Bassan et al., 1999; Offen et al., Brain Res. 854:257-262 (2000)).Several animal models have also demonstrated NAP activity on diseases ofthe CNS. In animal models simulating parts of the Alzheimer's diseasepathology, NAP was protective (Bassan et al., 1999; Gozes et al., J.Pharmacol. Exp. Ther. 293:1091-1098 (2000); see also U.S. Pat. No.6,613,740). In normal aging rats, intranasal administration of NAPimproved performance in the Morris water maze. (Gozes et al., J. Mol.Neurosci. 19:175-178 (2002). NAP reduced infarct volume and motorfunction deficits Mol. Neurosci. 19:175-178 (2002). NAP reduced infarctvolume and motor function deficits after ischemic injury, by decreasingapoptosis (Leker et al., Stroke 33:1085-1092 (2002)) and reducing damagecaused by closed head injury in mice by decreasing inflammation (BeniAdani et al., J. Pharmacol. Exp. Ther. 296:57-63 (2001); Romano et al.,J. Mol. Neurosci. 18:37-45 (2002); Zaltzman et al., NeuroReport14:481-484 (2003)). NAP has been shown to provide protectiveintervention in a model of fetal alcohol syndrome, reducing fetal demiseand growth restrictions. (Spong et. al., J Pharmacol Exp Ther. 297:774-9(2001)). Additionally, long term nasal NAP application in mice resultedin decreased anxiety (Alcalay et al., Neurosci Lett. 361(1-3):128-31(2004)).

SAL, a 9-amino acid peptide(SALLRSIPA=Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala); (SEQ ID NO:1), alsoknown as ADNF-9, was identified as the shortest active form of ADNF (seeU.S. Pat. No. 6,174,862). SAL has been shown in in-vitro assays and invivo disease models to keep neurons of the central nervous system alivein response to various insults (e.g. Gozes et al., 2000, infra;Brenneman et al., 1998. J. Pharmacol. Exp. Ther. 285, 619-627). D-SAL isan all D-amino acid derivative of SAL that is stable and orallyavailable (Brenneman, et al., J Pharmacol Exp Ther. 309:1190-7 (2004))and surprisingly exhibits similar biological activity (potency andefficacy) to SAL in the systems tested.

ADNF polypeptides, including NAP and SAL, and uses thereof inneuroprotection against disorders of the central nervous system, are thesubject of patents and patent applications including PCT WO 1/92333;U.S. Ser. No. 07/871,973 filed Apr. 22, 1992, now U.S. Pat. No.5,767,240; U.S. Ser. No. 08/342,297, filed Oct. 17, 1994 (published asWO96/11948), now U.S. Pat. No. 6,174,862; U.S. Ser. No. 60/037,404,filed Feb. 7, 1997 (published as WO98/35042); U.S. Ser. No. 09/187,330,filed Nov. 11, 1998 (published as WO00/27875); U.S. Ser. No. 09/267,511,filed Mar. 12, 1999 (published as WO00/53217); U.S. Pat. No. 6,613,740,U.S. Ser. No. 60/149,956, filed Aug. 18, 1999 (published as WO01/12654);U.S. Ser. No. 60/208,944, filed May 31, 2000; and U.S. Ser. No.60/267,805, filed Feb. 8, 2001; PCT/IL2004/000232, filed Mar. 11, 2004(published as WO 2004/080957) herein each incorporated by reference intheir entirety.

This disclosure provides new and surprising uses for ADNF polypeptides,including, e.g., NAP, SAL, D-NAP and D-SAL, in the treatment ofneurotoxicity in the peripheral nervous system.

BRIEF SUMMARY OF THE INVENTION

In one aspect, the present invention provides a method for treatingperipheral neurotoxicity in a subject, the method comprisingadministering a therapeutically effective amount of an ADNF polypeptideto a subject in need thereof.

In one embodiment, the ADNF polypeptide is a member selected from thegroup consisting of:

-   -   (a) an ADNF I polypeptide comprising an active core site having        the following amino acid sequence:        Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala (SEQ ID NO:1), or an        analogue thereof;    -   (b) an ADNF III polypeptide comprising an active core site        having the following amino acid sequence:        Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln (SEQ ID NO:2), or an analogue        thereof, and    -   (c) a mixture of the ADNF I polypeptide of part (a) and the ADNF        III polypeptide of part (b), or their respective analogues.

In another embodiment, the ADNF polypeptide is a member selected fromthe group consisting of a full length ADNF I polypeptide, a full lengthADNF III polypeptide (ADNP), and a mixture of a full length ADNF Ipolypeptide and a full length ADNF III polypeptide.

In one embodiment, the ADNF polypeptide is prepared by recombinant DNAmethodology. In another embodiment, the active core site of the ADNFpolypeptide comprises at least one D-amino acid. In another embodiment,the active core site of the ADNF polypeptide comprises all D-aminoacids.

In one embodiment, the ADNF I polypeptide has the formula(R1)x-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala-(R2)y (SEQ ID NO:20), or ananalogue thereof, in which

-   -   R1 is an amino acid sequence comprising from 1 to about 40 amino        acids wherein each amino acid is independently selected from the        group consisting of naturally occurring amino acids and amino        acid analogs;    -   R2 is an amino acid sequence comprising from 1 to about 40 amino        acids wherein each amino acid is independently selected from the        group consisting of naturally occurring amino acids and amino        acid analogs; and    -   x and y are independently selected and are equal to zero or one.

In one embodiment, the ADNF I polypeptide is selected from the groupconsisting of:

(SEQ ID NO: 3) Val-Leu-Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile- Pro-Ala;(SEQ ID NO: 4) Val-Glu-Glu-Gly-Ile-Val-Leu-Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 5)Leu-Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro- Ala; (SEQ ID NO: 6)Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 7)Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 8)Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 1)Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; and (SEQ ID NO: 28)SALLRSIPAPAGASRLLLLTGEIDLP.

In one embodiment, the ADNF I polypeptide comprises up to about 20 or 40amino acids at either or both of the N-terminus and the C-terminus ofthe active core site.

In another embodiment, the ADNF III polypeptide has the formula(R1)x-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln-(R2)y (SEQ ID NO:13), or ananalogue thereof, in which

-   -   R1 is an amino acid sequence comprising from 1 to about 40 amino        acids wherein each amino acid is independently selected from the        group consisting of naturally occurring amino acids and amino        acid analogs;    -   R2 is an amino acid sequence comprising from 1 to about 40 amino        acids wherein each amino acid is independently selected from the        group consisting of naturally occurring amino acids and amino        acid analogs; and    -   x and y are independently selected and are equal to zero or one.

In another embodiment, the ADNF III polypeptide is a member selectedfrom the group consisting of:

(SEQ ID NO: 9) Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln; (SEQ ID NO: 10)Leu-Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln-Gln- Ser; (SEQ ID NO: 11)Leu-Gly-Leu-Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro- Gln-Gln-Ser;(SEQ ID NO: 12) Ser-Val-Arg-Leu-Gly-Leu-Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln-Gln-Ser; and (SEQ ID NO: 2)Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln.

In another embodiment, the ADNF III polypeptide comprises up to about 20amino acids at least one of the N-terminus and the C-terminus of theactive core site.

In one embodiment, an ADNF I polypeptide of part (a) and an ADNF IIIpolypeptide of part (b) are administered to the subject.

In one embodiment, the ADNF polypeptide is administered intranasally. Inanother embodiment, the ADNF polypeptide is administered orally. Inanother embodiment, the ADNF polypeptide is administered intravenouslyor subcutaneously.

In one aspect the invention provides the use of an ADNF polypeptide inthe manufacture of a medicament for the treatment of peripheralneurotoxicity.

In one embodiment, the symptoms of said peripheral neurotoxicity aremeasured by motor dysfunction, muscle wasting, or a change selected fromamong a change in sense of smell, vision or hearing, deep tendonreflexes, vibratory sense, cutaneous sensation, gait and balance, musclestrength, orthostatic blood pressure, and chronic or intermittent pain.

In another embodiment, the peripheral neurotoxicity is a consequence oftreatment with one or more chemical agents. In another embodiment, theperipheral neurotoxicity is a consequence of treatment with a chemicalagent selected from among chemical agents for cancer, multiplesclerosis, gout, arthritis, Bechet's disease, psychiatric disorder,immunosuppression and infectious disease.

In another embodiment, one or more chemical agents is selected fromamong the vinca alkaloids (e.g., vincristine, vindesine, vinorelbine andvinblastine), platinum drugs (e.g., cisplatinum, carboplatinum),L-asparaginase and the taxanes (e.g., taxol, taxotere). In addition toanti-cancer agents, neurotoxicity may be caused by thalidomide,methotrexate, colchicine and anti-infective agents (including but notlimited to nucleoside analogs such as lamivudine, zalcitabine,didanosine and stavudine).

In another embodiment, peripheral neurotoxicity is a consequence of adisease process. In another embodiment, the disease process selectedfrom among diabetes, leprosy, Charcot-Marie-Tooth Disease, hereditarysensory and autonomic neuropathies (HSAN), Guillain-Barré syndrome,viral illnesses, (e.g., cytomegalovirus, Epstein-Barr virus,varicella-zoster virus, and human immunodeficiency virus (HIV)),bacterial infection (including Campylobacter jejuni and Lyme disease),chronic alcoholism, botulism, poliomyelitis, uremia, chronic kidneyfailure, and atherosclerosis.

In another aspect, the present invention provides, the treatment ofcancer or neoplasia comprising

-   -   a) administering an anti-cancer agent; and    -   b) administering, contemporaneously or sequentially with the        anti-cancer agent of step a), an ADNF polypeptide in a        pharmaceutically acceptable carrier.

In another aspect, the present invention provides a method of testingfor response to a therapeutic agent for a neurodegenerative disease orperipheral neurotoxicity comprising the following steps,

-   -   a) measuring olfaction capacity in a subject having a        neurodegenerative disease or potential peripheral neurotoxicity;    -   b) administering a therapeutic agent to the subject;    -   c) measuring olfaction capacity in the subject subsequent to        step b);    -   d) comparing olfaction capacity from step a) and step c).

In another embodiment, the therapeutic agent is an ADNF polypeptide. Inanother embodiment, the neurodegenerative disease is Alzheimer'sdisease. In another embodiment, the subject has potential peripheralneurotoxicity associated with treatment by a chemotherapeutic agent.

In another aspect, the present invention provides a method of treatmentof tauopathy in a subject comprising administering to a subject havingor suspected of having a tauopathy, a therapeutically effective amountof an ADNF polypeptide.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1: Rota-rod tests were performed on rats receiving 0.175 mg/kgvincristine, and similar rats receiving vincristine plus subcutaneousNAP. Rota-rod test shows vincristine and NAP treated animals (n=10)perform better than vincristine treated alone (n=10). (**p<0.01).

FIG. 2: Motor evaluations: The ability to exit a circle 30 cm indiameter within 20 seconds. Vincristine-treated rats (n=10) aresignificantly worse as compared to control animals (n=10) (P<0.001).Treatment with NAP (25 microgram/kg) (n=10) significantly improved theperformance similar to control values (P<0.01).

FIGS. 3, 4 and 5: Time spent with new odors: olfaction capacity. Thetime spent with each odor over the three consecutive tests was recorded.FIG. 3, for control rats, FIG. 4 for vincristine treated rats and FIG. 5for vincristine and 25 microgram/kg NAP-treated rats. While thevincristine-treated rats did not show any initial interest in the newsmell, a trend toward increased interest toward a new odor was observedin the control and the vincristine-NAP-treated rats.

FIG. 6: Comparison between time periods spent with a certain odor afterexchanging for a former scent-odor discrimination test: The figuredepicts 4 points, point 1=water (ddw) trial 3; point 2=odor #1, trial#1; point 3=odor #1, trial 3; point 4=odor #2, trial 1. Results showed asignificant difference in the time taken to sniff the third odor whencomparing control to vincristine-treated rats or vincristine-treatedrats with vincristine+25 microgram/kg NAP (P<0.05).

FIG. 7: Plantar tests were performed on rats receiving a total dose of5.6 mg/kg taxol, and similar rats receiving taxol plus 2.5 μg/kg/dayNAP. The plantar test shows taxol and 2.5 μg/kg/day NAP treated animals(n=10) perform better than taxol treated alone (n=10). (*p<0.01).

FIG. 8: Plantar tests were performed on rats receiving a total dose of 9mg/kg taxol, and similar rats receiving taxol plus 2.5 μg/kg/day NAP.The plantar test shows taxol and 2.5 μg/kg/day NAP treated animals(n=10) perform better than taxol treated alone (n=5). (*p<0.04).

FIG. 9: Rotarod tests were performed on rats receiving a total dose of 9mg/kg taxol, and similar rats receiving taxol plus 2.5 μg/kg/day NAP.The rotarod test shows taxol and 2.5 μg/kg/day NAP treated animals (n=5)perform better than taxol treated alone (n=10). (*p<0.04).

DEFINITIONS

The phrase “ADNF polypeptide” refers to one or more activity dependentneurotrophic factors (ADNF) that have an active core site comprising theamino acid sequence of SALLRSIPA (SEQ ID NO:1) (referred to as “SAL”) orNAPVSIPQ (SEQ ID NO:2) (referred to as “NAP”), or conservativelymodified variants thereof that have neurotrophic/neuroprotectiveactivity as measured with in vitro cortical neuron culture assaysdescribed by, e.g., Hill et al., Brain Res. 603:222-233 (1993);Brenneman & Gozes, J. Clin. Invest. 97:2299-2307 (1996), Gozes et al.,Proc. Natl. Acad. Sci. USA 93, 427-432 (1996). An ADNF polypeptide canbe an ADNF I polypeptide, an ADNF III polypeptide, their alleles,polymorphic variants, analogs, interspecies homolog, any subsequencesthereof (e.g., SALLRSIPA (SEQ ID NO:1) or NAPVSIPQ (SEQ ID NO:2)) orlipophilic variants that exhibit neuroprotective/neurotrophic action on,e.g., neurons originating in the central nervous system either in vitroor in vivo. An “ADNF polypeptide” can also refer to a mixture of an ADNFI polypeptide and an ADNF III polypeptide.

The term “ADNF I” refers to an activity dependent neurotrophic factorpolypeptide having a molecular weight of about 14,000 Daltons with a pIof 8.3±0.25. As described above, ADNF I polypeptides have an active sitecomprising an amino acid sequence of Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala(SEQ ID NO:1) (also referred to as “SALLRSIPA” or “SAL” or “ADNF-9”).See Brenneman & Gozes, J. Clin. Invest. 97:2299-2307 (1996), Glazner etal., Anat. Embryol. ((Berl). 200:65-71 (1999), Brenneman et al., J.Pharm. Exp. Ther., 285:619-27 (1998), Gozes & Brenneman, J. Mol.Neurosci. 7:235-244 (1996), and Gozes et al., Dev. Brain Res. 99:167-175(1997). Unless indicated as otherwise, “SAL” refers to a peptide havingan amino acid sequence of Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala (SEQ IDNO:1), not a peptide having an amino acid sequence of Ser-Ala-Leu. Afull length amino acid sequence of ADNF I can be found in WO 96/11948.

The phrase “ADNF III polypeptide” or “ADNF III” also calledactivity-dependent neuroprotective protein (ADNP) refers to one or moreactivity dependent neurotrophic factors (ADNF) that have an active coresite comprising the amino acid sequence of NAPVSIPQ (SEQ ID NO:2)(referred to as “NAP”), or conservatively modified variants thereof thathave neurotrophic/neuroprotective activity as measured with in vitrocortical neuron culture assays described by, e.g., Hill et al., BrainRes. 603, 222-233 (1993); Gozes et al., Proc. Natl. Acad. Sci. USA 93,427-432 (1996). An ADNF polypeptide can be an ADNF III polypeptide,allelelic or polymorphic variant, analog, interspecies homolog, or anysubsequences thereof (e.g., NAPVSIPQ; SEQ ID NO:2) that exhibitneuroprotective/neurotrophic action on, e.g., neurons originating in thecentral nervous system either in vitro or in vivo. ADNF III polypeptidescan range from about eight amino acids and can have, e.g., between 8-20,8-50, 10-100 or about 1000 or more amino acids.

Full length human ADNF III has a predicted molecular weight of 123,562.8Da (>1000 amino acid residues) and a pI of about 6.97. As describedabove, ADNF III polypeptides have an active site comprising an aminoacid sequence of Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln (SEQ ID NO:2) (alsoreferred to as “NAPVSIPQ” or “NAP”). See Zamostiano et al., J. Biol.Chem. 276:708-714 (2001) and Bassan et al., J. Neurochem. 72:1283-1293(1999). Unless indicated as otherwise, “NAP” refers to a peptide havingan amino acid sequence of Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln (SEQ ID NO:2),not a peptide having an amino acid sequence of Asn-Ala-Pro. Full-lengthamino acid and nucleic acid sequences of ADNF III can be found in WO98/35042, WO 00/27875, U.S. Pat. No. 6,613,740. The Accession number forthe human sequence is NP_(—)852107, see also Zamostiano et al., infra.

The term “amino acid” refers to naturally occurring and synthetic aminoacids, as well as amino acid analogs and amino acid mimetics thatfunction in a manner similar to the naturally occurring amino acids.Naturally occurring amino acids are those encoded by the genetic code,as well as those amino acids that are later modified, e.g.,hydroxyproline, γ-carboxyglutamate, and O-phosphoserine. For thepurposes of this application, amino acid analogs refers to compoundsthat have the same basic chemical structure as a naturally occurringamino acid, i.e., an a carbon that is bound to a hydrogen, a carboxylgroup, an amino group, and an R group, e.g., homoserine, norleucine,methionine sulfoxide, methionine methyl sulfonium. Such analogs havemodified R groups (e.g., norleucine) or modified peptide backbones, butretain the same basic chemical structure as a naturally occurring aminoacid. For the purposes of this application, amino acid mimetics refersto chemical compounds that have a structure that is different from thegeneral chemical structure of an amino acid, but that functions in amanner similar to a naturally occurring amino acid.

Amino acids may include those having non-naturally occurringD-chirality, as disclosed in WO 01/12654, incorporated herein byreference, which may improve oral availability and other drug likecharacteristics of the compound. In such embodiments, one or more, andpotentially all of the amino acids of NAP or the ADNF polypeptide willhave D-chirality. The therapeutic use of peptides can be enhanced byusing D-amino acids to provide longer half life and duration of action.However, many receptors exhibit a strong preference for L-amino acids,but examples of D-peptides have been reported that have equivalentactivity to the naturally occurring L-peptides, for example,pore-forming antibiotic peptides, beta amyloid peptide (no change intoxicity), and endogenous ligands for the CXCR4 receptor. In thisregard, NAP and ADNF polypeptides also retain activity in the D-aminoacid form (Brenneman et al., J. Pharmacol. Exp. Ther. 309(3):1190-7(2004), infra).

Amino acids may be referred to by either their commonly known threeletter symbols or by the one-letter symbols recommended by the IUPAC-IUBBiochemical Nomenclature Commission. Nucleotides, likewise, may bereferred to by their commonly accepted single-letter codes.

“Conservatively modified variants” applies to both amino acid andnucleic acid sequences. With respect to particular nucleic acidsequences, conservatively modified variants refers to those nucleicacids which encode identical or essentially identical amino acidsequences, or where the nucleic acid does not encode an amino acidsequence, to essentially identical sequences. Specifically, degeneratecodon substitutions may be achieved by generating sequences in which thethird position of one or more selected (or all) codons is substitutedwith mixed-base and/or deoxyinosine residues (Batzer et al., NucleicAcid Res. 19:5081 (1991); Ohtsuka et al., J. Biol. Chem. 260:2605-2608(1985); Rossolini et al., Mol. Cell. Probes 8:91-98 (1994)). Because ofthe degeneracy of the genetic code, a large number of functionallyidentical nucleic acids encode any given protein. For instance, thecodons GCA, GCC, GCG and GCU all encode the amino acid alanine. Thus, atevery position where an alanine is specified by a codon, the codon canbe altered to any of the corresponding codons described without alteringthe encoded polypeptide. Such nucleic acid variations are “silentvariations,” which are one species of conservatively modifiedvariations. Every nucleic acid sequence herein which encodes apolypeptide also describes every possible silent variation of thenucleic acid. One of skill will recognize that each codon in a nucleicacid (except AUG, which is ordinarily the only codon for methionine, andTGG, which is ordinarily the only codon for tryptophan) can be modifiedto yield a functionally identical molecule. Accordingly, each silentvariation of a nucleic acid which encodes a polypeptide is implicit ineach described sequence.

As to amino acid sequences, one of skill will recognize that individualsubstitutions, deletions or additions to a nucleic acid, peptide,polypeptide, or protein sequence which alters, adds or deletes a singleamino acid or a small percentage of amino acids in the encoded sequenceis a “conservatively modified variant” where the alteration results inthe substitution of an amino acid with a chemically similar amino acid.Conservative substitution tables providing functionally similar aminoacids are well known in the art. Such conservatively modified variantsare in addition to and do not exclude polymorphic variants, interspecieshomologs, and alleles of the invention.

The following groups each contain amino acids that are conservativesubstitutions for one another:

-   -   1) Alanine (A), Glycine (G);    -   2) Serine (S), Threonine (T);    -   3) Aspartic acid (D), Glutamic acid (E);    -   4) Asparagine (N), Glutamine (Q);    -   5) Cysteine (C), Methionine (M);    -   6) Arginine (R), Lysine (K), Histidine (H);    -   7) Isoleucine (1), Leucine (L), Valine (V); and    -   8) Phenylalanine (F), Tyrosine (Y), Tryptophan (W). (see, e.g.,        Creighton, Proteins (1984)).

One of skill in the art will appreciate that many conservativevariations of the nucleic acid and polypeptide sequences provided hereinyield functionally identical products. For example, due to thedegeneracy of the genetic code, “silent substitutions” (i.e.,substitutions of a nucleic acid sequence that do not result in analteration in an encoded polypeptide) are an implied feature of everynucleic acid sequence that encodes an amino acid. Similarly,“conservative amino acid substitutions,” in one or a few amino acids inan amino acid sequence are substituted with different amino acids withhighly similar properties (see the definitions section, supra), are alsoreadily identified as being highly similar to a disclosed amino acidsequence, or to a disclosed nucleic acid sequence that encodes an aminoacid. Such conservatively substituted variations of each explicitlylisted nucleic acid and amino acid sequences are a feature of thepresent invention.

The term “subject” refers to any mammal, in particular human, at anystage of life.

The term “contacting” is used herein interchangeably with the following:combined with, added to, mixed with, passed over, incubated with, flowedover, etc. Moreover, the ADNF III polypeptides or nucleic acids encodingthem of the present invention can be “administered” by any conventionalmethod such as, for example, parenteral, oral, topical, and inhalationroutes. In some embodiments, parenteral and nasal inhalation routes areemployed.

“Neurotoxicity” as used herein is defined as adverse effects on thestructure or functioning of the cells of the nervous system that resultfrom exposure to chemical substances or to disease processes. Amongother things, neurotoxicants can cause morphological changes that leadto generalized damage to nerve cells (neuronopathy), injury to axons(axonopathy), or destruction of the myelin sheath (myelinopathy). It iswell established that exposure to certain chemotherapeutic agents,agricultural and industrial chemicals can damage the nervous system,resulting in neurological and behavioral dysfunction. Symptoms ofneurotoxicity include muscle weakness, loss of sensation and motorcontrol, tremors, alterations in cognition, and impaired functioning ofthe autonomic nervous system. Neurotoxicological assessments use abattery of functional and observational tests. Neurotoxicity in humansis most commonly measured by neurological tests that assess cognitive,sensory, and motor function.

“Peripheral neurotoxicity” refers to neurotoxicity of the peripheralnervous system (PNS). The PNS includes all the nerves not in the brainor spinal cord, and includes the dorsal root ganglia (DRG). These nervescarry sensory information and motor impulses. Damage to the nerve fibersof the PNS can disrupt communication between the CNS and the rest of thebody. Peripheral neurotoxicity is also sometimes referred to in theliterature as peripheral neuropathy, and can include hundreds ofidentifiable conditions, as further described below. “Peripheralneuropathy” encompasses a wide range of conditions in which the nervesoutside of the brain and spinal cord have been damaged, and may includecrush injury and section.

“Central nervous system” or “CNS” means the brain and spinal cord.

The terms “polypeptide,” “peptide” and “protein” are usedinterchangeably herein to refer to a polymer of amino acid residues.Generally, a peptide refers to a short polypeptide. The terms apply toamino acid polymers in which one or more amino acid residue is an analogor mimetic of a corresponding naturally occurring amino acid, as well asto naturally occurring amino acid polymers.

As used herein ‘treatment’ includes preventative treatment orprophylaxis, such as treatment for prevention of disease progression oronset of further symptoms, or for avoidance or reduction of side-effectsor symptoms of a disease.

As used herein, ‘disease’ includes an incipient condition or disorder orsymptoms of a disease, incipient condition or disorder.

The terms “isolated,” “purified” or “biologically pure” refer tomaterial that is substantially or essentially free from components thatnormally accompany it as found in its native state.

“An amount sufficient” or “an effective amount” or a “therapeuticallyeffective amount” is that amount of an ADNF polypeptide that exhibitsthe activity of interest or which provides either a subjective relief ofa symptom(s) or an objectively identifiable improvement as noted by theclinician or other qualified observer. In therapeutic applications, theADNF polypeptides of the invention are administered to a patient in anamount sufficient to reduce or eliminate symptoms of the disease. Anamount adequate to accomplish this is defined as the “therapeuticallyeffective dose.” The dosing range varies with the ADNF polypeptide used,the route of administration and the potency of the particular ADNFpolypeptide, as further set out below, and as described in patents CAPatent 2202496, U.S. Pat. No. 6,174,862 and U.S. Pat. No. 6,613,740.

“Inhibitors,” “activators,” and “modulators” of expression or ofactivity are used to refer to inhibitory, activating, or modulatingmolecules, respectively, identified using in vitro and in vivo assaysfor expression or activity, e.g., ligands, agonists, antagonists, andtheir homologs and mimetics. The term “modulator” includes inhibitorsand activators. Inhibitors are agents that, e.g., inhibit expression ofa polypeptide or polynucleotide of the invention or bind to, partiallyor totally block stimulation or enzymatic activity, decrease, prevent,delay activation, inactivate, desensitize, or down regulate the activityof a polypeptide or polynucleotide of the invention, e.g., antagonists.Activators are agents that, e.g., induce or activate the expression of apolypeptide or polynucleotide of the invention or bind to, stimulate,increase, open, activate, facilitate, enhance activation or enzymaticactivity, sensitize or up regulate the activity of a polypeptide orpolynucleotide of the invention, e.g., agonists. Modulators includenaturally occurring and synthetic ligands, antagonists, agonists, smallchemical molecules and the like. Assays to identify inhibitors andactivators include, e.g., applying putative modulator compounds tocells, in the presence or absence of a polypeptide or polynucleotide ofthe invention and then determining the functional effects on apolypeptide or polynucleotide of the invention activity. Samples orassays comprising a polypeptide or polynucleotide of the invention thatare treated with a potential activator, inhibitor, or modulator arecompared to control samples without the inhibitor, activator, ormodulator to examine the extent of effect. Control samples (untreatedwith modulators) are assigned a relative activity value of 100%.Inhibition is achieved when the activity value of a polypeptide orpolynucleotide of the invention relative to the control is about 80%,optionally 50% or 25-1%. Activation is achieved when the activity valueof a polypeptide or polynucleotide of the invention relative to thecontrol is 110%, optionally 150%, optionally 200-500%, or 1000-3000%higher.

DETAILED DESCRIPTION OF THE INVENTION

This invention discloses the surprising finding that an ADNF polypeptidethat was shown previously to be neuroprotective of the CNS and toprovide cognitive enhancement can alternatively be used in the treatmentof peripheral neurotoxicity induced by chemical agents or diseaseprocesses. The invention is supported by the findings set out in theExamples that in vivo administration of NAP peptide significantlyreduces peripheral neurotoxicity induced by chemical agents.

ADNF Polypeptides: Composition and Synthesis

In one embodiment, the ADNF polypeptides of the present inventioncomprise the following amino acid sequence:(R¹)_(x)-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln-(R²)_(y) (SEQ ID NO:13) andconservatively modified variations thereof. In this designation, R¹denotes the orientation of the amino terminal (NH₂ or N-terminal) endand R² represents the orientation of the carboxyl terminal (COOH orC-terminal) end.

In the above formula, R¹ is an amino acid sequence comprising from 1 toabout 40 amino acids, wherein each amino acid is independently selectedfrom the group consisting of naturally occurring amino acids and aminoacid analogs. The term “independently selected” is used herein toindicate that the amino acids making up the amino acid sequence R¹ maybe identical or different (e.g., all of the amino acids in the aminoacid sequence may be threonine, etc.). Moreover, as previouslyexplained, the amino acids making up the amino acid sequence R¹ may beeither naturally occurring amino acids, or known analogues of naturalamino acids that functions in a manner similar to the naturallyoccurring amino acids (i.e., amino acid mimetics and analogs). Suitableamino acids that can be used to form the amino acid sequence R¹ include,but are not limited to, those listed in Table I, infra. The indexes “x”and “y” are independently selected and can be equal to one or zero.

As with R¹, R², in the above formula, is an amino acid sequencecomprising from 1 to about 40 amino acids, wherein each amino acid isindependently selected from the group consisting of naturally occurringamino acids and amino acid analogs. Moreover, as with R¹, the aminoacids making up the amino acid sequence R² may be identical ordifferent, and may be either naturally occurring amino acids, or knownanalogues of natural amino acids that functions in a manner similar tothe naturally occurring amino acids (i.e., amino acid mimetics andanalogs). Suitable amino acids that can be used to form R² include, butare not limited to, those listed in Table I, infra.

As used herein, “NAP” or “NAP peptide” refers to the formula above wherex and y both equal 0. “NAP related peptide” refers to any of the othervariants of NAP which are described the formula.

R¹ and R² are independently selected. If R¹ R² are the same, they areidentical in terms of both chain length and amino acid composition. Forexample, both R¹ and R² may be Val-Leu-Gly-Gly-Gly (SEQ ID NO:14). If R¹and R² are different, they can differ from one another in terms of chainlength and/or amino acid composition and/or order of amino acids in theamino acids sequences. For example, R¹ may be Val-Leu-Gly-Gly-Gly (SEQID NO:14), whereas R² may be Val-Leu-Gly-Gly (SEQ ID NO:15).Alternatively, R¹ may be Val-Leu-Gly-Gly-Gly (SEQ ID NO:14), whereas R²may be Val-Leu-Gly-Gly-Val (SEQ ID NO:16). Alternatives, R¹ may beVal-Leu-Gly-Gly-Gly (SEQ ID NO:14), whereas R² may beGly-Val-Leu-Gly-Gly (SEQ ID NO:17).

Within the scope of the above formula, certain NAP and NAP relatedpolypeptides are preferred, namely those in which x and y are both zero(i.e. NAP). Equally preferred are NAP and NAP related polypeptides inwhich x is one; R¹ Gly-Gly; and y is zero. Also equally preferred areNAP and NAP related polypeptides in which is one; R¹ is Leu-Gly-Gly; yis one; and R² is -Gln-Ser. Also equally preferred are NAP and NAPrelated polypeptides in which x is one; R¹ is Leu-Gly-Leu-Gly-Gly- (SEQID NO:18); y is one; and R² is -Gln-Ser. Also equally preferred are NAPand NAP related polypeptides in which x is one; R¹ isSer-Val-Arg-Leu-Gly-Leu-Gly-Gly- (SEQ ID NO:19); y is one; and R² is-Gln-Ser. Additional amino acids can be added to both the N-terminus andthe C-terminus of the active peptide without loss of biologicalactivity.

In another aspect, the present invention provides pharmaceuticalcompositions comprising one of the previously described NAP and NAPrelated polypeptides in an amount sufficient to exhibit desiredtherapeutic activity, in a pharmaceutically acceptable diluent, carrieror excipient. In one embodiment, the NAP or NAP related peptide has anamino acid sequence selected from the group consisting of SEQ ID NO:2,and 9-12, and conservatively modified variations thereof.

In another embodiment, the ADNF polypeptide comprises the followingamino acid sequence:(R¹)_(x)-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala-(R²)_(y) (SEQ ID NO:27) andconservatively modified variations thereof. In this designation, R¹denotes the orientation of the amino terminal (NH₂ or N-terminal) endand R² represents the orientation of the carboxyl terminal (COOH orC-terminal) end.

In the above formula, R¹ is an amino acid sequence comprising from 1 toabout 40 amino acids, wherein each amino acid is independently selectedfrom the group consisting of naturally occurring amino acids and aminoacid analogs. The term “independently selected” is used herein toindicate that the amino acids making up the amino acid sequence R¹ maybe identical or different (e.g., all of the amino acids in the aminoacid sequence may be threonine, etc.). Moreover, as previouslyexplained, the amino acids making up the amino acid sequence R¹ may beeither naturally occurring amino acids, or known analogues of naturalamino acids that functions in a manner similar to the naturallyoccurring amino acids (i.e., amino acid mimetics and analogs). Suitableamino acids that can be used to form the amino acid sequence R¹ include,but are not limited to, those listed in Table I, infra. The indexes “x”and “y” are independently selected and can be equal to one or zero.

As with R¹, R², in the above formula, is an amino acid sequencecomprising from 1 to about 40 amino acids, wherein each amino acid isindependently selected from the group consisting of naturally occurringamino acids and amino acid analogs. Moreover, as with R¹, the aminoacids making up the amino acid sequence R² may be identical ordifferent, and may be either naturally occurring amino acids, or knownanalogues of natural amino acids that functions in a manner similar tothe naturally occurring amino acids (i.e., amino acid mimetics andanalogs). Suitable amino acids that can be used to form R² include, butare not limited to, those listed in Table I, infra.

As used herein, “SAL” or “SAL peptide” refers to the formula above wherex and y both equal 0. “SAL related peptide” refers to any of the othervariants of SAL which are described the formula.

R¹ and R² are independently selected. If R¹ R² are the same, they areidentical in terms of both chain length and amino acid composition.Additional amino acids can be added to both the N-terminus and theC-terminus of the active peptide without loss of biological activity.

In another aspect, the present invention provides pharmaceuticalcompositions comprising one of the previously described SAL andSAL-related polypeptides in an amount sufficient to desired therapeuticactivity, in a pharmaceutically acceptable diluent, carrier orexcipient. In one embodiment, the SAL or SAL related peptide has anamino acid sequence selected from the group consisting of SEQ ID NO:1and 3-8, and conservatively modified variations thereof. In a furtherembodiment, the SAL related peptide comprises SALLRSIPAPAGASRLLLLTGEIDLP(SEQ ID NO:21). The sequence SALLRSIPAPAGASRLLLLTGEIDLP (SEQ ID NO:21)is also known as Colivelin and is a combination of the SAL active siteand a derivative of the Humanin protein named AGA-(C8R)HNG17. Colivelinis described in Chiba et al., J. Neurosci. 25:10252-10261 (2005), whichis herein incorporated by reference for all purposes.

It will be readily apparent to those of ordinary skill in the art thatpreferred ADNF polypeptides can readily be selected for peripheralneuroprotective activity by employing suitable assays and animal modelsknown to those skilled in the art, some of which are disclosed herein.

In addition, one of skill in the art will recognize that a variety ofchemical modifications can be made to the peptides without diminishingtheir biological activity. In addition to replacement of specific aminoacids with other amino acids, there may also be a wide range ofmodifications to specific amino acids, and conjugates with a widevariety of polymers, proteins, carbohydrates or other organic moieties.

The peptides of the invention may be prepared via a wide variety ofwell-known techniques. Peptides of relatively short size are typicallysynthesized on a solid support or in solution in accordance withconventional techniques (see, e.g., Merrifield, Am. Chem. Soc.85:2149-2154 (1963)). Various automatic synthesizers and sequencers arecommercially available and can be used in accordance with knownprotocols (see, e.g., Stewart & Young, Solid Phase Peptide Synthesis(2nd ed. 1984)). Solid phase synthesis in which the C-terminal aminoacid of the sequence is attached to an insoluble support followed bysequential addition of the remaining amino acids in the sequence is thepreferred method for the chemical synthesis of the peptides of thisinvention. Techniques for solid phase synthesis are described by Barany& Merrifield, Solid-Phase Peptide Synthesis; pp. 3-284 in The Peptides:Analysis, Synthesis, Biology. Vol. 2: Special Methods in PeptideSynthesis, Part A.; Merrifield et al 1963; Stewart et al. 1984). NAP andrelated peptides are synthesized using standard Fmoc protocols (Wellings& Atherton, Methods Enzymol. 289:44-67 (1997)).

Other synthetic methods for peptides include liquid phase synthesis(e.g. Fischer and Zheleva J Pept Sci. 8(9):529-42 (2002).

In addition to the foregoing techniques, the ADNF peptides, inparticular the full length proteins ADNF I and ADNF III for use in theinvention may be prepared by recombinant DNA methodology. Generally,this involves creating a nucleic acid sequence that encodes the protein,placing the nucleic acid in an expression cassette under the control ofa particular promoter, and expressing the protein in a host cell.Recombinantly engineered cells known to those of skill in the artinclude, but are not limited to, bacteria, yeast, plant, filamentousfungi, insect (especially employing baculoviral vectors) and mammaliancells.

Use of ADNF Polypeptides for Treating Peripheral Neurotoxicity

Peripheral neurotoxicity may be identified and diagnosed in a subject bya variety of techniques. Typically it may be measured by motordysfunction, muscle wasting, or a change in sense of smell, vision orhearing, or changes in deep tendon reflexes, vibratory sense, cutaneoussensation, gait and balance, muscle strength, orthostatic bloodpressure, and chronic or intermittent pain. In humans these symptoms arealso sometimes demonstrative of toxic effects in both the PNS and theCNS. Ultimately, there are hundreds of possible peripheral neuropathiesthat may result from neurotoxicity. Reflecting the scope of PNSactivity, symptoms may involve sensory, motor, or autonomic functions.They can be classified according to the type of affected nerves and howlong symptoms have been developing.

Peripheral neurotoxicity can be induced by chemotherapeutic agents(anti-cancer, anti-microbial and the like) and by disease processes.These two different areas are discussed separately below.

Regarding chemotherapeutic agents, it is well known that patientsexposed to agents such as Vinca alkaloids, suramin, taxanes, andcisplatin can develop peripheral neurotoxicity. Neurologicalobservations published in recent years indicate that administration oftaxanes and cisplatin in patients affected by neoplasm induces nervedeficits in a dose- and time-dependent manner. (Bedikian A. Y., et al.1995. J. Clin. Oncol., 13: 2895-2899). Moreover, when platinum compoundsand taxanes are used in combination, the patients develop more severeperipheral neuropathies. The pathophysiology of chemotherapeuticagent-induced neuropathy is still not clear, although a variety ofstudies have shown that taxanes interfere with axonal transport, causingaxonal distal sensory-motor lesions, whereas platinum compounds inducesensory neuropathy acting mainly on the neuronal cell bodies of thespinal ganglion. Pathological and electrophysiological studies have alsoindicated that neurons of the dorsal root ganglion are selectivelydamaged after cisplatin treatment. It has been reported that thedevelopment of this peripheral neurotoxicity can induce clinicians tointerrupt therapy to prevent more severe neurological deficits (Amato A.A., Collins M. P. Semin. Neurol., 18: 125-142, 1998.). Because of theneurotoxic effects, much effort has been devoted to the identificationof potential neuroprotective agents. It is reasonable, therefore, tohypothesize that ADNF polypeptides, which can prevent neurotoxicityand/or promote peripheral innervation after chemotherapy, will beclinically useful. Those skilled in the art are familiar withchemotherapeutic agents that may cause peripheral neurotoxicities. Ingeneral such chemotherapeutic agents are used in the treatment ofcancer, multiple sclerosis, gout, arthritis, Bechet's disease,psychiatric disorders, familial Mediterranean fever, amyloidosis,immunosuppression and infectious disease. A representative list includesvinca alkaloids (vincristine, vindesine, vinorelbine and vinblastine),platinum drugs (cisplatinum, carboplatinum), L-asparaginase and thetaxanes (taxol, taxotere). In addition to anti-cancer agents,neurotoxicity may be cause by thalidomide, methotrexate, colchicine andanti-infective agents (including but not limited to nucleoside analogssuch as lamivudine, zalcitabine, didanosine and stavudine).

The method of the invention recognizes that administration of atherapeutically effective amount of an ADNF polypeptide is useful totreat or prevent peripheral neurotoxicity in a subject receiving achemotherapeutic agent, such as those described above. Relative to theadministration of the chemotherapeutic agent, the administration of theADNF polypeptide can occur before, at the same time, subsequent to or onan irregular basis. Those skilled in the art are able to identify asuitable temporal relationship between the agents which is designed toestablish peripheral neuroprotection before the consequences of theneurotoxicity develop. Treatment may continue until chemotherapeuticagent is discontinued, or until the neurotoxicity resulting from theagent is resolved and not expected to worsen.

When administered non-contemporaneously (e.g. sequentially) with thechemotherapeutic agent, the ADNF polypeptide will typically beformulated separately from the agent. When administeredcontemporaneously, it may be advantageous to provide the ADNFpolypeptide in a dosage form in combination with the agent. Thus theinvention recognizes a formulation of a chemotherapeutic agent and anADNF polypeptide, wherein the dose of the ADNF polypeptide is effectiveto reduce or eliminate the peripheral neurotoxicity associated with thechemotherapeutic agent. Those skilled in the art are able to select aproper dose of ADNF polypeptide based this disclosure and on theanticipated neurotoxic effects of the selected chemotherapeutic agent.

As mentioned previously, certain disease processes can also result inperipheral neurotoxicity. For example, the diabetes/peripheralneuropathy link has been well established. A typical pattern ofdiabetes-associated neuropathic symptoms includes sensory effects thatfirst begin in the feet. The associated pain or pins-and-needles,burning, crawling, or prickling sensations form a typical “stocking”distribution in the feet and lower legs.

Other diseases that may result in peripheral neurotoxicity includeinherited or acquired disorders, including infectious diseases. Suchdiseases include leprosy, Charcot-Marie-Tooth Disease, Inheritedneurological disorders such as the hereditary sensory and autonomicneuropathies (HSAN), Guillain-Barré syndrome which may arise fromcomplications associated with viral illnesses, such as cytomegalovirus,Epstein-Barr virus, and human immunodeficiency virus (HIV), or bacterialinfection, including Campylobacter jejuni and Lyme disease. Otherwell-known causes of peripheral neuropathies include chronic alcoholism,infection varicella-zoster virus, botulism, and poliomyelitis.Peripheral neuropathy may develop as a primary symptom, or it may beless significant. Uremia, or chronic kidney failure, carries a 10-90%risk of eventually developing neuropathy, and there may be anassociation between liver failure and peripheral neuropathy.Accumulation of lipids inside blood vessels (atherosclerosis) canchoke-off blood supply to certain peripheral nerves.

As recognized in the case of chemotherapeutic agents, use of ADNFpolypeptides to treat or prevent neurotoxicity from disease processesrequires administration of a therapeutically effective amount of an ADNFpolypeptide sufficient to treat or prevent peripheral neurotoxicity in asubject suffering from such disease. In this case, relative to the onsetof the peripheral neurotoxicity, the administration of the ADNFpolypeptide can occur before, at the same time, subsequent to or on anirregular basis. Those skilled in the art are able to identify asuitable temporal relationship between the agents which is designed toestablish peripheral neuroprotection before the consequences of thedisease induced neurotoxicity develop. Treatment may continue until theunderlying disease resolves, or until the neurotoxicity resulting fromthe disease is resolved and not expected to worsen. In some cases,administration of ADNF polypeptides may be chronic.

Because the disease processes of concern to this invention are oftentreated with other therapeutic agents, the invention recognizes that itmay be advantageous to provide the ADNF polypeptide in a dosage form incombination with such an agent. Thus the invention recognizes aformulation of a therapeutic agent and an ADNF polypeptide, wherein thedose of the ADNF polypeptide is effective to reduce or eliminate theperipheral neurotoxicity associated with the chemotherapeutic agent.Those skilled in the art are able to select a proper dose of ADNFpolypeptide based this disclosure and on the anticipated neurotoxiceffects of the selected therapeutic agent.

Use of ADNF Polypeptides to Treat Tauopathy and Related Diseases

Tauopathy means the accumulation of microtubule-associated protein tauin the neuronal and glial cytoplasm. This terminology is relatively new,but it relates to neurodegenerative diseases evidencing widespreadaccumulation of tau epitopes both in neurons and glia, sometimes withoutdeposition of amyloid beta protein. Tauopathy is now considered to beone of the primary causes of neuronal degeneration, with about one thirdof the very elderly presenting with deposition of abnormallyphosphorylated tau proteins with relative paucity of amyloid betaprotein (Abeta). In the course of neurofibrillary tangle formation(including tau aggregates), the major proteinaceous components of theselesions undergo post-translational modifications. In the case of tau,these include phosphorylation of mainly serine and threonine, but alsotyrosine residues. In addition, tau is subject to ubiquitination,nitration, truncation, prolyl isomerization, association with heparansulfate proteoglycan, glycosylation, glycation and modification byadvanced glycation end-products (AGEs). Human tauopathies includeAlzheimer's disease and frontotemporal dementia with parkinsonism linkedto chromosome 17 (Chen et al. Curr Drug Targets. 5(6):503-15 (2004)).Furthermore, recent studies have shown that as a consequence ofchemotherapy there was an increase in cerebrospinal fluid tau, which isa marker of neurodegeneration (Van Gool et al. Leukemia. 14:2076-84(2000); Lee et al., Biochem. Biophys Acta. 1739: 251-9 (2005))

The instant invention relates to a method of treatment of tauopathy in asubject comprising administering to the subject a therapeuticallyeffective amount of an ADNF polypeptide. Treatment of tauopathy with theNAP peptide is a specific embodiment of this invention.

The inventors have recognized, based on the instant disclosure, thatADNF polypeptides such as NAP effectively prevent neurotoxic damage bythe vinca alkaloid vincristine (see Examples), and without wishing to bebound to any particular theory or mechanism of action, that this effectof NAP can be combined with the teachings of PCT publication WO2004/080957 (Gozes et al.) and Divinski et al. J Biol Chem.279(27):28531-8. (2004) that demonstrate that NAP interacts with tubulinto enhance microtubule formation and stabilize microtubular structure inglial and neural cells, to establish for the first time that NAP isuseful for the treatment of tauopathy. Other peptides of the ADNF familyincluding ADNF-9 (or SAL) and all D-amino acids SAL (termed D-SAL,Brenneman et al. (2004), infra) as well as full length ADNP (ADNFIII)interact with tubulin. (Furman et al., Neuron Glia Biology 1:193-9(2004).

It is well recognized that tau performs an important function ofstabilizing and maintaining the microtubular network, that in turn isimportant for axonal transport in neurons. The formation of thepathological neurofibrillary tangles which results from thehyperphosphorylation of tau, leads to microtubule breakdown and impairedaxonal transport (Ishihara et al. Neuron 24:751-62 (1999); Lee et al.,Annu Rev Neurosci. 24:1121-59 (2001); Morfini et al. Neuromolecular Med.2:89-99 (2002); Gozes. J Mol Neurosci. 19(3):337-8 (2002)). Divinski etal. J Biol Chem. 279(27):28531-8. (2004) have demonstrated that exposureto zinc toxicity resulted in microtubule breakdown in astrocytes andneurons and that NAP protects these cells from this toxicity bypromoting the reorganization of the microtubular network. In the sameexperiments, tubulin was identified as a NAP binding molecule.Furthermore, in the presence of NAP, there is an increase in the ratioof non-phosphorylated tau to phosphorylated tau (Gozes & Divinski,Journal of Alzheimer's Disease 6(6 Suppl.):S37-41 (2004)) and increasedneurite outgrowth, a process that is dependent on slow axoplasmictransport (Lagreze et al., Invest Opthalmol Vis Sci. 46:933-8 (2005);Gozes. Neurochem Int. 4:101-20 (1982); Smith-Swintosky et al. J MolNeurosci. 25:225-38 (2005). Therefore, it is possible that NAP functionsto promote the assembly and stability of the microtubular network eitherdirectly by binding to tubulin or indirectly through changes in thelevels of the different forms of tau. The promotion of propermicrotubule assembly is also important in the case of vicristinetreatment, as vincristine and related compounds facilitate the tubulinspiral filaments and aggregated spiral formation (Verdier-Pinard et al.Biochem Pharmacol. 58(6):959-71 (1999)) Any other tubulin binding andmodifying agents including, but not limited to vinca alkaloids(vincristine, vindesine, vinorelbine and vinblastine), the taxanes(taxol, taxotere), nocodazole and colchicines will affect axoplasmictransport which can in turn be protected by the specific neuroprotectiveeffect of NAP treatment (Gozes et al. J Mol Neurosci. 20(3):315-22,(2003)).

Use of Olfaction Testing to Measure Effectiveness of NeurologicalTherapeutics, such as ADNF Polypeptides.

Olfaction disabilities, including hyposmia (reduction in ability totaste and smell) or anosmia (total loss of ability to taste and smell),are associated with neurodegenerative disease (such as Alzheimer'sdisease, multiple sclerosis, Huntington disease, amyotrophic lateralsclerosis, Parkinson's disease and others) and peripheral neurotoxicityinduced by chemotherapeutic agents and by disease processes. In allthese cases, olfaction disabilities are generally progressive.

The present invention provides a method to identify whether a subjecthaving a neurodegenerative disease or peripheral neurotoxicity isresponding to therapeutic agents administered to treat the disease bymeasuring olfaction in the subject. A response to therapy is indicatedeither by an improvement in olfaction capacity or quality of the subjectafter treatment with a therapeutic agent, or at least a reduction, aftersuch treatment, in the degree of hyposmia or the progress of hyposmia toanosmia that would be expected in subjects with untreated disease.

While the method can be used to test response to any therapeutic agentfor the treatment of the neurodegenerative disease or the peripheralneurotoxicity, in particular, this invention provides a method toidentify a response to therapy with ADNF polypeptide.

The method involves testing for response to a therapeutic agent for aneurodegenerative disease comprising the following steps: a) measuringolfaction capacity in a subject having a neurodegenerative disease orpotential peripheral neurotoxicity; b) administering a therapeutic agentto the subject; c) measuring olfaction capacity in the subjectsubsequent to step b); and d) comparing olfaction capacity from step a)and step c).

Based on the results of the comparison of step d), the subject andcare-giver can determine whether there is either an improvement inolfaction capacity or quality of the subject after treatment with atherapeutic agent, or at least a reduction, after such treatment, in thedegree of hyposmia or the progress of hyposmia to anosmia that would beexpected in subjects with untreated disease, thus indicating a responseto the therapeutic agent, or not. Patients and care-givers can then goon to decide whether treatment with the therapeutic agent shouldcontinue or be halted.

This method provides many advantages for assessing a response to atherapeutic agent, in particular because olfaction is one of the firstsenses to be lost or diminished as a result of a neurodegenerativedisease or the onset of peripheral neurotoxicity.

Pharmaceutical Administration

ADNF polypeptides of the invention are generally administered in apharmaceutical formulation. Suitable formulations for use in the presentinvention are found in Remington's Pharmaceutical Sciences (17th ed.1985). In addition, for a brief review of methods for drug delivery, seeLanger, Science 249:1527-1533 (1990).

As such, the present invention provides for therapeutic compositions ormedicaments comprising one or more of the ADNF polypeptides describedherein in combination with a pharmaceutically acceptable excipient,wherein the amount of the ADNF polypeptide is sufficient to provide atherapeutic effect.

The ADNF polypeptides of the present invention are embodied inpharmaceutical compositions intended for administration by any effectivemeans, including parenteral, topical, nasal, oral, pulmonary (e.g. byinhalation) or local administration. Preferably, the pharmaceuticalcompositions are administered parenterally, e.g., intravenously,subcutaneously, intradermally, intramuscularly, or intranasally.

Thus, the invention provides compositions for parenteral administrationthat comprise a solution of ADNF polypeptide, as described above,dissolved or suspended in an acceptable carrier, preferably an aqueouscarrier. A variety of aqueous carriers may be used including, forexample, water, buffered water, 0.4% saline, 0.3% glycine, hyaluronicacid and the like. These compositions may be sterilized by conventional,well known sterilization techniques or, they may be sterile filtered.The resulting aqueous solutions may be packaged for use as is orlyophilized, the lyophilized preparation being combined with a sterilesolution prior to administration. The compositions may containpharmaceutically acceptable auxiliary substances as required toapproximate physiological conditions including pH adjusting andbuffering agents, tonicity adjusting agents, wetting agents and thelike, such as, for example, sodium acetate, sodium lactate, sodiumchloride potassium chloride, calcium chloride, sorbitan monolaurate,triethanolamine oleate, etc.

For solid compositions, conventional nontoxic solid carriers may be usedthat include, for example, pharmaceutical grades of mannitol, lactose,starch, magnesium stearate, sodium saccharin, talcum, cellulose,glucose, sucrose, magnesium carbonate, and the like. For oraladministration, a pharmaceutically acceptable nontoxic composition isformed by incorporating any of the normally employed excipients, such asthose carriers previously listed, and generally 10-95% of activeingredient and more preferably at a concentration of 25%-75%.

For aerosol administration, the ADNF polypeptides are preferablysupplied in finely divided form along with a surfactant and propellant.The surfactant must, of course, be nontoxic, and preferably soluble inthe propellant. Representative of such agents are the esters or partialesters of fatty acids containing from 6 to 22 carbon atoms, such ascaproic, octanoic, lauric, palmitic, stearic, linoleic, linolenic,olesteric and oleic acids with an aliphatic polyhydric alcohol or itscyclic anhydride. Mixed esters, such as mixed or natural glycerides maybe employed. A carrier can also be included, as desired, as with, e.g.,lecithin for intranasal delivery. An example includes a solution inwhich each milliliter included 7.5 mg NaCl, 1.7 mg citric acidmonohydrate, 3 mg disodium phosphate dihydrate and 0.2 mg benzalkoniumchloride solution (50%) (Gozes et al., J Mol Neurosci. 19(1-2):167-70(2002)). The ADNF polypeptides of the invention can therefore be used inthe manufacture of a medicament for the treatment or prevention ofperipheral neurotoxicity. The medicament can comprise any of thepharmaceutical formulations contemplated herein, with any amount ofactive ingredient (e.g. ADNF polypeptide) contemplated herein.

In therapeutic applications, the ADNF polypeptides of the invention areadministered to a patient in an amount sufficient to reduce or eliminatesymptoms of peripheral neurotoxicity. An amount adequate to accomplishthis is defined as “therapeutically effective dose.” Amounts effectivefor this use will depend on, for example, the particular NAP or ADNFpolypeptide employed, the type of disease or disorder to be prevented,the manner of administration, the weight and general state of health ofthe patient, and the judgment of the prescribing physician.

For example, an amount of polypeptide falling within the range of a 100ng to 10 mg dose given intranasally once a day (e.g., in the evening)would be a therapeutically effective amount. Alternatively, dosages maybe outside of this range, or on a different schedule. For example,dosages may range from 0.0001 mg/kg to 1000 mg/kg, and will preferablybe about 0.001 mg/kg, 0.1 mg/kg, 1 mg/kg, 5 mg/kg, 50 mg/kg or 500 mg/kgper dose. Doses may be administered hourly, every 4, 6 or 12 hours, withmeals, daily, every 2, 3, 4, 5, 6, or 7 days, weekly, every 2, 3, 4weeks, monthly or every 2, 3 or 4 months, or any combination thereof.The duration of dosing may be single (acute) dosing, or over the courseof days, weeks, months, or years, depending on the condition to betreated. Those skilled in the art can determine the suitable dosage, andmay rely on preliminary data reported in Gozes et al., 2000, Gozes etal., 2002), Bassan et al. 1999; Zemlyak et al., Regul. Pept. 96:39-43(2000); Brenneman et al., Biochem. Soc. Trans. 28: 452-455 (2000);Erratum Biochem Soc. Trans. 28:983; Wilkemeyer et al. Proc. Natl. Acad.Sci. USA 100:8543-8548 (2003)). Suitable dose ranges are described inthe examples provided herein, as well as in WO 9611948.

It must be noted that as used herein and in the appended claims, thesingular forms “a”, “and”, and “the” include plural referents unless thecontext clearly dictates otherwise. Thus, for example, reference to “acell” includes a plurality of such cells and equivalents thereof knownto those skilled in the art, and so forth.

The publications discussed herein are provided solely for theirdisclosure prior to the filing date of the present application. Nothingherein is to be construed as an admission that the present invention isnot entitled to antedate such publication by virtue of prior invention.Further, the dates of publication provided may be different from theactual publication dates which may need to be independently confirmed.Citations are incorporated herein by reference.

EXAMPLES Example 1 Intranasal Administration of NAP Decreases PeripheralNeurotoxicity Induced by Vinca Alkaloids in Rats

The present study was designed to evaluate if NAP treatment successfullyreduced peripheral neurotoxicity induced by the vinca alkaloidvincristine in rats.

Methods

Rats (200-300 g), divided into 4 groups of 10, were injected withvincristine sulfate dissolved in saline. Stock concentration was 2mg/ml, pH 4.5-5.2. Aliquots of the drug were diluted daily in saline toconcentrations of 0.175 mg/ml and were administered i.p. at a dose of0.175 mg/kg. NAP was prepared at 0.1 mg/1.3 ml in saline (0.9% NaCl) andabout 0.1 ml was injected subcutaneously to a ˜300 g rat to achieve adose of 25 microgram/kg (exact calculations were made based on the dailybody weights). For 2.5 microgram/kg, the injection solution was dilutedby 10 and again 0.1 ml was injected per rat. Treatments took place daily(5 days a week) for ˜3 weeks (20 days) with the dosage calculated ondaily body weight. NAP was administered at the same time as thevincristine, in the dosage and the amount where indicated the followingschedule.

Four groups were evaluated: 1) Control, saline (n=10), 2) Vincristine(i.p.) 0.175 mg/kg (n=10), 3) Vincristine (i.p.) 0.175 mg/kg+NAP (s.c.)2.5 microgram/kg (n=10), and 4) Vincristine (i.p.) 0.175 mg/kg+NAP(s.c.) 25 microgram/kg (n=10).

After a week cessation of treatment, a final boost of vincristine wasgiven i.p. daily for three days and NAP at 25 microgram/kg was givenintranasally to group number 4 only. The intranasal formulation followedprevious experiment (7.5 mg Sodium Chloride, 1.7 mg Citric AcidMonohydrate, 3.0 mg Disodium Phosphate Dihydrate, 0.2 mg BenzalkoniumChloride Solution (50%) per 1 mL Sterile Water (U.S.P.) Alcalay et al.,infra). For behavioral testing baseline toxin effects were evaluated2-23 days following the first injection, using the testing proceduresbelow:

1) Rota-Rod

Vincristine treated animals show impaired performance on the rota-rodtest which evaluates muscle innervation and strength (Boyle et al., JPharmacol Exp Ther 279: 410-415 (1996)) Here, the rota-rod test wasperformed on days 3, 8, 15 and 23 after the initiation of thevincristine injections.

In the Rota-rod test a rodent is placed on a rotating rod. The speed ofrotation is gradually increased and the rodent's ability to remain onthe rotating rod is recorded. Here, the speed was gradually increasedfrom 3-30 rpm every 30 seconds with 3 rpm increments up to 200 seconds.The time spent on the rota-rod without falling was recorded. Impairedanimals fall earlier from the rota-rod. The time spent by each animal ina single treatment group was summed for all treatment and test days asseen on FIG. 1. Statistical analysis showed a significant differencebetween the vincristine treated animals and the control animalsindicating impairment in the vincristine animals (P<0.01). Group 3treatment with NAP (2.5 microgram/kg) significantly improved theperformance similar to control values Animals treated with NAP (25micrograms/kg) in group 4 showed no significant difference from animalstreated with vincristine treated alone and were significantly differentfrom controls.

2) Motor Evaluation

Motor examination was performed on days 6, 9, 13 and 24 after theinitiation of the vincristine injections. Rats were examined aftervincristine injection, with the use of a motor disability scale.(Bederson J B, et al., Stroke. 1986; 17: 472-476; Leker R R, et al., JNeurol Sci. 1999; 162: 114-119).

Animals were assessed based on their failure to walk out of a circle 30cm in diameter within 20 seconds.

FIG. 2 shows the results of motor evaluations. The ability to exit a 30cm in diameter within 20 seconds was significantly reduced forvincristine-treated rats as compared to control animals (P<0.001).Additional treatment with NAP (25 microgram/kg) in group 4 significantlyimproved the performance similar to control values (P<0.01). Animalstreated with NAP (2.5 micrograms/kg) in group 3 showed no significantdifference from animals treated with vincristine alone.

3) Olfactory Discrimination Test

Treatments took place daily (5 days a week) for ˜3 weeks (20 days) withthe dosage calculated on daily body weight. NAP was administeredsubcutaneously at the same time as the vincristine was administeredintraperitoneally, in the dosage and the amount indicated in theschedule above. After a week cessation of treatment a final boost ofvincristine was given i.p. daily for three days and NAP at 25microgram/kg was given intranasally to group number 4 only. Theintranasal formulation followed the previous experiment (Alcalay et al.,infra). An olfactory discrimination test was performed on each of thethree days of NAP treatment during the final boost period. (Macknin etal., Brain Res. 1000, 174-78 (2004)) The odors tested were 1) Deionizedwater (ddw) and 2) Scented extracts, i.e., vanilla/almond.

Overall the experiment included 3 odors (water and two scented extracts)each encompassing 3 trials of 2 minutes. New dipped tip was introducedat the beginning of each trial for the different scents.

Thirty minutes before the testing the subjects were housed in separatecages and a cotton tip dipped in water was placed hanging into the cage.During these 30 minutes the animal was acclimatized to the tip and thecage. Thereafter, the cotton tip was dipped in the desired scent andplaced hanging from the top of the cage.

The duration (seconds) of tip sniffing with count starting when the noseof the animal is approximately 1 cm. from the tip and stopping when theanimal places its paws on the tip or tries to bite it reflects olfactoryresponses.

If the animal can discriminate odors, then each trial of the same scentit will be less and less interested—thus the sniffing time will go down.But when the odor is replaced by a new one—the sniffing time willincrease.

T-test was used to make comparisons of individual test groups withcontrol group or between unpaired groups.

FIGS. 3-5 show the time spent with new odors, i.e., olfaction capacity.The time spent with each odor over the three consecutive tests wasrecorded. FIG. 3, for control rats (Group 1), FIG. 4 for vincristinetreated rats (Group 2) and FIG. 5 for vincristine and 25 microgram/kgNAP treated rats (Group 4). While the Group 2 vincristine-treated ratsdid not show any initial interest in the new smell, a trend towardincreased interest toward a new odor was observed in the control and thevincristine-NAP treated rats. These results were further evaluated inFIG. 6.

FIG. 6 shows a comparison between time periods spent with a certain odorafter exchanging for a new scent-odor discrimination test: The figuredepicts 4 points, point 1=water (ddw) trial 3; point 2=odor #1, trial#1; point 3=odor #1, trial 3; point 4=odor #2, trial 1. Results showed asignificant difference in the time taken to sniff the third odor whencomparing vincristine-treated rats (Group 2) to either control rats(Group 1) or to vincristine+25 microgram/kg NAP rats (Group 4) (P<0.05).

Results

The result of these three independent tests evaluating peripheralneurotoxicity, specifically muscle innervation or strength (e.g.rota-rod test); Motor abilities (movement and circle exit); andbehavioral/olfaction abilities, indicates that treatment of animals withNAP significantly reduced impairment and evidence of peripheralneurotoxicity that results from vincristine treatment.

The results of the olfaction experiment in particular demonstrates thatintranasal NAP provides a benefit to animals that lose olfactioncapacity as a result of chemotherapy. This supports the finding thatmeasurement of olfaction capacity can be used to determine whethersubjects are responding to ADNF polypeptide treatment, either forneurodegenerative disease or peripheral neurotoxicity, by measuringwhether the progress of hyposmia or anosmia has been halted, reduced orreversed in patients receiving treatment with ADNF polypeptides.

Example 2 Administration of NAP Reduces Neurotoxicity Induced byChemotherapeutic Agents

Aim of the study: The aim of the present randomized blind study is toinvestigate the efficacy of NAP in reducing neurotoxicity induced by thechemotherapeutic agent vincristine in men and women with advancedcarcinoma.

Methods:

Initially 21 patients with advanced carcinoma are randomized betweengroups A and B. In group A (11 patients) NAP is administered at a doseof 15 mg/45-70 kg before vincristine infusion (1.4 mg/m²). In group B(10 patients) the same chemotherapeutic protocol is followed withoutadministration of NAP. Before beginning of chemotherapy and after 6chemotherapeutic cycles all patients will undergo clinical neurologicexamination and nerve conduction study by a neurologist who is blind tothe randomization.

Results:

Clinical neurologic examination is assessed neurotoxicity indicatorssuch as tendon reflexes, superficial sensory perception and musclestrength, as well as neuropathic symptoms. Nerve conduction studyassesses nerve conduction velocity and action potential amplitude in 7peripheral nerves. Deterioration of nerve conduction parameters, tendonreflexes, muscle strength, superficial sensory perception, but also ofpatient's symptoms is significantly more severe in group B.

Conclusion:

Concurrent NAP administration will be found to significantly reduceneurotoxicity induced by the chemotherapeutic agent vincristine in menand women with advanced carcinoma.

Example 3 Randomized Trial with or without NAP to Reduce NeurotoxicitySide Effects Under Chemotherapy with Oxaliplatin (L-OHP), FA/5-FU

Aim of the study: Chemotherapy with L-OHP, FA, 5-FU has a high activityin advanced colorectal cancer (ACRC). The main dose-limiting toxicity ofchemotherapy with L-OHP is a peripheral sensory neuropathy. In thisstudy the patients (pts) will receive a chemotherapy with L-OHP, FA and5-FU with or without NAP. The question is whether a reduction of sideeffects of neurotoxicity is seen after application of NAP.

Materials and Methods

We include 27 patients with ACRC. In arm A chemotherapy is applied withL-OHP 85 mg/m2 d1, FA 500 mg/m2 d1+d2 and 5-FU 4000 mg/m2 over 48 hcontinuous infusion as biweekly schedule. In arm B, 15 mg/45-70 kg NAPis given over 10 min i.v. before application of the same schedule ofchemotherapy. Investigation of toxicity, neurological examination and ablood count is performed before every cycle. For a daily documentationof the side effects every patient receives a questionnaire. The NAPgroup shows a significant reduction of peripheral neurotoxicity. In theNAP group grade II/III leucopenia occurs at a lower frequency than inthe control group.

Conclusion

Side effects such as peripheral neurotoxicity under chemotherapyincluding L-OHP, FA/5-FU will be reduced under supportive care with NAP.

Example 4 Taxol Neurotoxicity and Protection by NAP

The present study was designed to evaluate whether NAP treatmentsuccessfully reduced peripheral neurotoxicity induced by the taxanetaxol in rats.

Methods

Experiment 1

Forty Sprague-Dawley rats (eight weeks old) were divided into fourgroups that received the following treatments: a) 10% Cremophor EL inSaline; b) taxol for a cumulative dose of 5.6 mg/kg; c) taxol for acumulative dose of 5.6 mg/kg+NAP 2.5 μg/kg/Day; or d) taxol for acumulative dose of 5.6 mg/kg+NAP 25 μg/kg/Day. The taxol wasreconstituted in a vehicle of 10% Cremophor EL in Saline.

Taxol treatments were administered four times intraperitoneally (i.p.)on nonconsecutive days in a volume of 250 μl each time. NAP wasadministered daily on 8 consecutive days from the first day of taxolinjection (with a 2 day brake on the weekend).

Rats were tested in the rota-rod and plantar test. The rota-rod test isdescribed above and assesses muscle strength. The plantar test evaluatesthermal hyperalgesia. For the plantar test, each rat was placed in aclear plastic chamber with a plastic floor and allowed a short period toacclimatize to the new environment (approximately 2-5 min). The animalswere then challenged with a radiant Infrared (IR) heat source directedat the plantar surface of the hind paw from below (7371 Plantar Test,Ugo Basile). The withdrawal latency of both the ipsilateral andcontralateral hind paw was evaluated. The infrared intensity was set atIR55 and the maximum length of exposure to the IR source was eighteenseconds. Statistical differences were tested by ANOVA and by t-test.

Results:

A statistically significant difference between groups was observed onlyin the plantar test and results are shown in FIG. 7. After the lasttaxol injection on day three, the taxol-treated rats exhibited thermalhyperalgesia, which was ameliorated by 2.5 μg/kg/day NAP injections. 25ug/kg NAP did not affect the plantar test. The hyperalgesia induced bythe taxol treatment diminished after 4 days. Rota-rod experiments didnot show statistically significant differences between groups in thisexperiment.

Experiment 2

Fifteen Sprague-Dawley Rats (seven weeks old) were randomly divided intothree groups that received the following treatments: a) 10% Cremophor ELin Saline; b) taxol for a cumulative dose of 9 mg/kg; or c) taxol for acumulative dose of 9 mg/kg+2.5 μg/kg/Day NAP. The taxol wasreconstituted in a vehicle of 10% Cremophor EL in Saline.

Taxol was administered twice on nonconsecutive days; each rat received0.4-0.5 ml Taxol solution (i.p.). NAP was administered in 0.1 ml volumefor five consecutive days starting with first injection of Taxol.

The rats were tested a day after the last Taxol injection on rota-rodand plantar tests as described above. Statistical significance was onlyobserved using non-paired, one tail t-test.

Results

Results are shown in FIG. 8 (Plantar test) and FIG. 9 (Rota-rod test).Taxol-treated rats exhibited a significant thermal hyperalgesia eightdays after the last Taxol injection. The hyperalgesia was ameliorated byNAP treatment. At this higher dose of Taxol, a significant effect onneuromuscular function was measured using the rota-rod test five daysafter the first taxol injection. The neuromuscular effect wasameliorated by NAP treatment.

Conclusion:

NAP protects against Taxol-induced neuropathy in vivo.

The examples set out above are intended to be exemplary of the effectsof the invention, and are not intended to limit the embodiments or scopeof the invention contemplated by the claims set out below. Othervariants of the invention will be readily apparent to one of ordinaryskill in the art and are encompassed by the appended claims. Allpublications, databases, Genbank sequences, GO terms, patents, andpatent applications cited herein are hereby incorporated by reference.

1. A method for the treatment of cancer or neoplasia with reduced peripheral neurotoxicity, the method comprising a) administering an anti-cancer agent to a subject in need thereof; and b) administering, contemporaneously or sequentially with the anti-cancer agent of step a), an ADNF polypeptide in an effective amount in a pharmaceutically acceptable carrier, thereby reducing peripheral neurotoxicity associated with the anti-cancer agent, wherein the ADNF polypeptide is a member selected from the group consisting of: (i) an ADNF I polypeptide comprising an active core site having the amino acid sequence of Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala (SEQ ID NO:1), wherein at least one amino acid in SEQ ID NO:1 is optionally a D-amino acid; (ii) an ADNF III polypeptide comprising an active core site having the amino acid sequence of Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln (SEQ ID NO:2), wherein at least one amino acid in SEQ ID NO:2 is optionally a D-amino acid; and (iii) a mixture of the ADNF I polypeptide of part (i) and the ADNF III polypeptide of part (ii).
 2. The method of claim 1, wherein said anti-cancer agent is a vinca alkaloid.
 3. The method of claim 1, wherein the ADNF polypeptide is a member selected from the group consisting of a full length ADNF I polypeptide, a full length ADNF III polypeptide (ADNP), and a mixture of a full length ADNF I polypeptide and a full length ADNF III polypeptide.
 4. The method of claim 1, wherein the ADNF polypeptide is an ADNF I polypeptide of part (i).
 5. The method of claim 1, wherein the active core site of the ADNF polypeptide comprises at least one D-amino acid.
 6. The method of claim 1, wherein the ADNF I polypeptide has the formula (R¹)_(x)-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala-(R²)_(y) (SEQ ID NO:20), in which R¹ is an amino acid sequence comprising from 1 to about 40 amino acids wherein each amino acid is independently selected from the group consisting of naturally occurring amino acids and amino acid analogs; R² is an amino acid sequence comprising from 1 to about 40 amino acids wherein each amino acid is independently selected from the group consisting of naturally occurring amino acids and amino acid analogs; and x and y are independently selected and are equal to zero or one.
 7. The method of claim 6, wherein the ADNF I polypeptide is Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala (SEQ ID NO:1).
 8. The method of claim 6, wherein the ADNF I polypeptide is selected from the group consisting of: (SEQ ID NO: 3) Val-Leu-Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile- Pro-Ala; (SEQ ID NO: 4) Val-Glu-Glu-Gly-Ile-Val-Leu-Gly-Gly-Gly-Ser-Ala- Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 5) Leu-Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro- Ala; (SEQ ID NO: 6) Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 7) Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 8) Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; and (SEQ ID NO: 1) Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala.


9. The method of claim 6, wherein the ADNF I polypeptide comprises up to about 20 amino acids at either or both of the N-terminus and the C-terminus of the active core site.
 10. The method of claim 1, wherein the ADNF polypeptide is an ADNF III polypeptide of part (ii).
 11. The method of claim 10, wherein the ADNF III polypeptide has the formula (R¹)_(x)-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln-(R²)_(y) (SEQ ID NO:13), in which R¹ is an amino acid sequence comprising from 1 to about 40 amino acids wherein each amino acid is independently selected from the group consisting of naturally occurring amino acids and amino acid analogs; R² is an amino acid sequence comprising from 1 to about 40 amino acids wherein each amino acid is independently selected from the group consisting of naturally occurring amino acids and amino acid analogs; and x and y are independently selected and are equal to zero or one.
 12. The method of claim 10, wherein the ADNF III polypeptide is Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln (SEQ ID NO:2).
 13. The method of claim 10, wherein the active core site of the ADNF III polypeptide comprises at least one D-amino acid.
 14. The method of claim 10, wherein the ADNF III polypeptide is a member selected from the group consisting of: (SEQ ID NO: 9) Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln; (SEQ ID NO: 10) Leu-Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln-Gln- Ser; (SEQ ID NO: 11) Leu-Gly-Leu-Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro- Gln-Gln-Ser; (SEQ ID NO: 12) Ser-Val-Arg-Leu-Gly-Leu-Gly-Gly-Asn-Ala-Pro-Val- Ser-Ile-Pro-Gln-Gln-Ser; and (SEQ ID NO: 2) Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln.


15. The method of claim 10, wherein the ADNF III polypeptide comprises up to about 20 amino acids at either or both of the N-terminus and the C-terminus of the active core site.
 16. The method of claim 1, wherein a mixture of the ADNF I polypeptide of part (i) and the ADNF III polypeptide of part (ii) is administered to the subject.
 17. The method of claim 16, wherein either or both active core sites of the ADNF I polypeptide and the ADNF III polypeptide comprise at least one D-amino acid.
 18. The method of claim 16, wherein the ADNF I polypeptide is Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala (SEQ ID NO:1), and wherein the ADNF III polypeptide is Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln (SEQ ID NO:2).
 19. The method of claim 16, wherein the ADNF I polypeptide is a member selected from the group consisting of: (SEQ ID NO : 3) Val-Leu-Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile- Pro-Ala; (SEQ ID NO: 4) Val-Glu-Glu-Gly-Ile-Val-Leu-Gly-Gly-Gly-Ser-Ala- Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 5) Leu-Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro- Ala; (SEQ ID NO: 6) Gly-Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 7) Gly-Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; (SEQ ID NO: 8) Gly-Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; and (SEQ ID NO: 1) Ser-Ala-Leu-Leu-Arg-Ser-Ile-Pro-Ala; and wherein the ADNF III polypeptide is selected from the group consisting of: (SEQ ID NO: 9) Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln; (SEQ ID NO: 10) Leu-Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln-Gln- Ser; (SEQ ID NO: 11) Leu-Gly-Leu-Gly-Gly-Asn-Ala-Pro-Val-Ser-Ile-Pro- Gln-Gln-Ser; (SEQ ID NO: 12) Ser-Val-Arg-Leu-Gly-Leu-Gly-Gly-Asn-Ala-Pro-Val- Ser-Ile-Pro-Gln-Gln-Ser; and (SEQ ID NO: 2) Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln.


20. The method of claim 16, wherein the ADNF I polypeptide comprises up to about 20 amino acids at either or both of the N-terminus and the C-terminus of the active core site of the ADNF I polypeptide, and wherein the ADNF III polypeptide comprises up to about 20 amino acids at either or both of the N-terminus and the C-terminus of the active core site of the ADNF III polypeptide.
 21. The method of claim 1, wherein the ADNF polypeptide is administered intranasally, orally, intravenously or subcutaneously. 